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Med Surg II > Exam 3: Cancer > Flashcards

Exam 3: Cancer Flashcards

1
Q

_________ is defined as a neoplastic disorder characterized by abnormal cellular differentiation & proliferation

A

Cancer

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2
Q

What word means “New Growth” ?

A

Neoplasm

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3
Q

True or False: Cancer is a universal disease that affects people without regard, to race, sex, socioeconomic status, or culture ?

A

True

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4
Q

True or False: Cancer is now treated as a chronic disease rather than a terminal disease ?

A

True

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5
Q

________ are “just a growth” that can be either benign or malignant ?

A

Tumors

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6
Q

What does it mean if cells are “well-differentiated” ?

A

They act & look like the normal cell

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7
Q

What are characteristics of Benign tumors ?

A
  • Limited growth
  • Localized
  • Cell’s are well-differentiated
  • Does not invade surrounding tissue
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8
Q

What are characteristics of Malignant tumors ?

A
  • Rapid or Slow growth
  • Spread throughout the body
  • Invasive to distant sites
  • Cells poorly differentiated
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9
Q

What does it mean if cells are “ poorly differentiated” ?

A

They DON’T look like normal cells

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10
Q

What are 3 examples of malignant tumors that have rapid growth ?

A
  • Lung cancer
  • Hematologic cancer
  • Leukemic cancer
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11
Q

What is an Example of a malignant tumor that has slow growth ?

A

Prostate cancer

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12
Q

____________ are defined as a substance or agent that causes the development or increases the incidence of cancer ?

A

Carcinogens

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13
Q

What are examples of different kinds of carcinogens that can cause cancer ?

A
  • Chemical
  • Physical
  • Genetic susceptibility
  • Viruses
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14
Q

What type of a carcinogen is defined as “ repeated injury to tissue” ?

A

Physical carcinogen

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15
Q

What are Examples of chemical carcinogens ?

A
  • Benzine
  • Arsenic
  • Formaldehyde
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16
Q

What types of cancers can be d/t Genetic Susceptibility ?`

A
  • Breast cancer
  • Colon cancer
  • Ovarian cancer
  • Pancreatic cancer
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17
Q

What are examples of viruses that can be linked to cancer ?

A
  • HPV
  • HIV
  • Hep B
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18
Q

What viral cancer causes cancer of the cervix in women & cancer of the head and neck in both sexes ?

A

HPV

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19
Q

What Virus can causes Kaposi Sarcoma ?

A

HIV

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20
Q

What virus can increase the chance of Liver cancer ?

A

Hepatitis B

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21
Q

Types of Cancer are classified how ?

A

By cell type and orgin

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22
Q

What are the different types of cancer classifications ?

A
  • Carcinoma
  • Sarcoma
  • Lymphoma
  • Leukemia
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23
Q

Carcinoma cancers usually originate where ?

A
  • Skin
  • Glands
  • Mucosa linings
    - lungs
    - GI tract
    - GU
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24
Q

Lymphoma cancers are generally seen where ?

A

Lymphatic tissues

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25
Q

Leukemia’s generally affect what ?

A

Bone Marrow

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26
Q

What grade of a tumor cannot be assessed ?

A

Grade V (5)

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27
Q

What grade of a tumor has “mild dysplasia (well-differentiated; low grade) ?

A

Grade I

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28
Q

The classification of tumors is based on what ?

A

The extent of the disease

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29
Q

What Classification System is used to assess tumors ?

A

TNM

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30
Q

What does the classification system TNM stand for ?

A

T - tumor
N - degree of regional spread to lymph nodes
M - metastasis

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31
Q

Staging of tumors/cancers Can Not be done until when ?

A

Until full diagnostic workups have been completed

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32
Q

What does “ in situ” mean ?

A

Means the cancer has no tendency to invade other tissue

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33
Q

What stage is defined as “Cancer in situ” ?

A

Stage 0

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34
Q

In what stage is the tumor limited to the tissue of origin ?

A

Stage 1

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35
Q

In what stage is the cancer limited to local spread ?

A

Stage 2

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36
Q

In what stage does the cancer have extensive local and regional spread ?

A

Stage 3

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37
Q

In what stage of cancer is there widespread metastasis ?

A

Stage 4

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38
Q

What type of diagnostics are used to look for cancer ?

A
  • Blood tests
  • Pap Smear
  • Proctoscopic Exams
  • Radiologic exams
  • Biopsy
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39
Q

What diagnostic test is considered a definitive test ?

A

Biopsy

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40
Q

What are goals of treatment for individuals with cancer ?

A
  • Cure
  • Control
  • Palliation
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41
Q

What are Treatment options for cancer ?

A
  • Surgery
  • Radiation
  • Chemotherapy
  • Biologic therapy
  • Targeted therapy
  • Stem cell transplant
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42
Q

what are reasons why Surgical therapy is used ?

A
  • Diagnosis
  • staging
  • cure
  • palliation
  • adjuvant tx
  • oncological emergencies
  • pain control
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43
Q

Why is surgical therapy used ?

A

To cure or control tumor growth

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44
Q

True or False: When using surgical therapy a margin of surrounding normal tissue must be removed at time of surgery “clean margins” ?

A

True

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45
Q

Radiation is used to do what ?

A
  • Cure
  • Control
  • Palliate
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46
Q

True or False: Radiation therapy is used alone or in combination with other modalities ?

A

True

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47
Q

Why is radiation therapy used ?

A

Used for inoperable tumors to reduce size, control growth, and relieve pain or obstruction

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48
Q

What routes can radiation therapy be given ?

A
  • External

- Internal

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49
Q

What is the goal of Chemotherapy ?

A

To reduce the # of malignant cancer cells in the tumor site(s)

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50
Q

True or False: Chemotherapy is used both systemically and regionally ?

A

True

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51
Q

How is systemic chemotherapy usually given ?

A

through IV

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52
Q

How is regional chemotherapy given ?

A

Insert a catheter directly into the organ//area causing the cancer

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53
Q

Chemotherapy is used for most ______________ & _________________ ?

A
  • Solid tumors

- hematologic cancers

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54
Q

What type of therapy targets rapidly dividing cells which has the potential for toxicity to normal cells ?

A

Chemotherapy

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55
Q

True or False: Patients are usually treated with a combination of drugs to affect cancer at different cell stages ?

A

True

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56
Q

What are some side effects of chemotherapy ?

A
  • sore throat
  • difficulty swallowing
  • esophagitis
  • nausea
  • vomiting
  • diarrhea
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57
Q

Effects of radiation are very specific to what ?

A

the specific radiation field involved

ex: Brain

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58
Q

The effects of chemo tend to be what ?

A

Generalized to the entire body or different parts of the body

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59
Q

What are the Hematologic side effects of chemo & radiation ?

A
  • Neutropenia (low WBCs)
  • Thrombocytopenia (low platelets)
  • Anemia
60
Q

What are the GI effects of chemo & radiation ?

A
  • Nausea
  • Vomiting
  • Anorexia
  • Diarrhea
  • Stomatitis (inflammation of the mouth & lips)
  • Mucositis (inflammation & ulceration of the mucous membranes lining the digestive tract)
  • Esophagitis
61
Q

What are integumentary side effects of chemo & radiation ?

A
  • Skin changes

- Alopecia (loss of hair)

62
Q

What are pulmonary side effects of chemo & radiation ?

A

Pneumonitis

general inflammation of lung tissue

63
Q

What are Cardiovascular side effects of chemo & radiation ?

A
  • Pericarditis

- Cardiotoxicity

64
Q

What are Genitourinary side effects of chemo & radiation ?

A
  • Cystitis
  • Nephrotoxicity
  • Reproductive dysfunction
65
Q

What are Nervous System side effects of chemo & radiation ?

A
  • ICP

- Cognitive & peripheral neuropathy

66
Q

What is Neutropenia ?

A

Low neutrophil count (WBCs)

67
Q

What neutrophil range is considered to put an individual at moderate risk for infection ?

A

500 - 1000

68
Q

What neutrophil rage is considered to put an individual at severe risk for infection ?

A

Less than 500

69
Q

Neutropenia is more common with patients receiving what type of therapy ?

A

Chemotherapy

70
Q

With Neutropenia there is a risk for what ?

A

Serious life threatening infections

71
Q

What things/areas do we want to make sure to assess is someone with Neutropenia ?

A
  • skin
  • mouth
  • GI tract
  • peri-rectal areas
  • lungs
  • urinary tract
72
Q

What things do we want to monitor in pt’s with Neutropenia ?

A
  • WBCs
  • Signs of infection
  • Culture during fever spikes
    (CXR, blood, UA, sputum, stool, drainage)
73
Q

For pt’s who are Neutropenic, they may receive what, to stimulate neutrophil production ?

A

Neupogen (filgrastim)

74
Q

What are Pt teaching points for pt’s with Neutropenia ?

A
  • Avoid sources of infection
    • People w/ infections
    • People recently vaccinated with live attenuated viruses
  • Avoid fresh fruits, plants, & flowers near bedside
  • Avoid cleaning litter boxes
  • Good personal hygiene
    • bathe daily
    • wash hands before eating & meal prep
    • Keep nails short
  • Avoid enemas, rectal suppositories, & thermometers
  • Report signs of infection immediately!!
75
Q

Pt’s with Neutropenia should report signs of infection immediately. What are the signs ?

A
  • Fever > 38ºC (100.4ºF)
  • Cough
  • Sore throat
  • Shaking
  • Chills
  • Painful or frequent urination
  • vaginal discharge
76
Q

True or False: if a pt with Neutropenia has a fever they will have a fever workup including things such as CXR, 2 sets of blood cultures,

A

True

77
Q

What is Thrombocytopenia ?

A

Low platelet count

78
Q

The potential for spontaneous bleeding or injury is seen with what hematologic problem in cancer pt’s ?

A

Thrombocytopenia

79
Q

What should we assess for in pt’s with Thrombocytopenia ?

A

Bleeding

80
Q

With a platelet count of < 50,000/mm3 there is what ?

A

An increased risk for bleeding

81
Q

With a platelet count of < 20,000/mm3 there is what ?

A

An increased risk for spontaneous cerebral bleeding or GI bleeding

82
Q

In cancer pt’s with Thrombocytopenia, what bleeding precautions should be taken ?

A
  • No IM injections

- Avoid veni-punctures

83
Q

What are pt teaching points for cancer pt’s who have thrombocytopenia ?

A
  • Prevent trauma to skin & mucous membranes
  • Avoid dental work or surgery
  • Avoid enemas, rectal suppositories & thermometers
  • Use toothettes or nonabrasive cleaning…
  • Avoid straight edge razors
  • Avoid drugs containing ASA
  • Humidify air
  • Use lotions & lubricants on skin & lips
84
Q

________ is common with chemo & radiation, and typically has a later onset ?

A

Anemia

85
Q

What does Anemia cause ?

A

Impaired oxygenation

86
Q

Impaired oxygenation from anemia can cause what types of things ?

A
  • Fatigue

- Activity intolerance

87
Q

How is anemia treated ?

A

Procrit (epoetin)

  • Can Increase RBC’s/production
88
Q

What are pt teaching points for a pt with Anemia ?

A
  • Avoid walking barefoot
  • Plan rest periods
  • Conserve energy
89
Q

Pt’s with Anemia should report what types of things ?

A
  • Bleeding gums
  • Increased bruising
  • Petachiae
  • Hypermenorrhea
  • Tarry stools
  • Blood in urine
  • Coffee-ground emesis
90
Q

_________ affects most cancer patients ?

A

Fatigue

91
Q

When a pt has fatigue, we should assess for possible causes. What are some possible causes of fatigue ?

A
  • Anemia
  • Chronic pain
  • Stress
  • Depression
  • Inadequate rest
  • Poor nutrition
92
Q

What are some pt teaching points for someone with fatigue ?

A
  • Conserve energy
  • Rest when tires
  • Plan for rest periods
  • Plan for gradual increase of activity
  • Monitor dietary and fluid intake
    (fluid intake: 2-3L per day)
93
Q

In pt’s with Anemia, what do we want to monitor ?

A

H&H

94
Q

True or False: Cells in the mucosal lining of the GI tract are highly proliferative & are most sensitive to chemo & radiation ?

A

True

95
Q

For patients who experience Nausea, vomiting, and anorexia, what do we want to do before treatment ?

A

Pre-medicate

  • as much as 4hrs before coming to hospital, or 1hr. All Depends on the patient and how they’ve reacted previously
  • Want to get ahead of Nausea before Tx is started/given
  • May get a steroid before Tx
96
Q

What do we want to monitor for in pt’s who have Nausea, Vomiting, or Anorexia ?

A

Monitor fluid & electrolyte status

97
Q

What type of medications are given for pt’s who experience Nausea, Vomiting, or Anorexia ?

A
  • Zolfran (blocks serotonin)
  • Anxiolytic (Ex: Ativan)
  • Compazine (anti-nausea)
98
Q

When monitoring fluid & electrolyte status in somebody who has Nausea, Vomiting, or Anorexia, what are specifically looking at ?

A
  • Potassium & Magnesium

* these 2 affect cardiac & muscle function !

99
Q

What are patient teaching points for cancer pt’s who are experiencing Nausea, Vomiting & Anorexia ?

A
  • Eat frequent small meals
  • Avoid greasy, fatty foods, candy & sweet foods
  • Avoid unpleasant sights, odors, and tastes
  • With some pt’s - hot foods are not tolerated well
  • Cold foods, salty foods, & dry toast may be more tolerable !
  • Report weight loss to healthcare provider
100
Q

____________ is a reaction of the bowel mucosa to radiation and certain chemo ?

A

Diarrhea

101
Q

What part of the bowel is more sensitive to chemo & radiation ?

A

Small bowel (AKA: small intestine)

102
Q

What is a common medication that is used to slow down diarrhea in pt’s receiving chemo & radiation ?

A

Loperamide (aka: Imodium)

103
Q

For pt’s who experiencing Diarrhea from chemo & radiation, what kind of diet do we want to encourage ?

A

Low fiber diet
(because, we want things to move more slowly through the GI tract)

  • no fruits or vegetables. –> want to keep it bland
104
Q

For pt’s with Diarrhea, what foods do we want to tell them to avoid ?

A

Avoid…

  • fried foods
  • fatty foods
  • dairy
105
Q

for pt’s experiencing Diarrhea as a side effect from treatment, what do we want them to have during treatment (radiation) ?

A

A full bladder

106
Q

Why do we want pt’s who are experiencing Diarrhea, to have a full bladder during radiation treatment ?

A

It helps move the small intestine out of the field of radiation

107
Q

What things do we want to monitor in pt’s who are experiencing Diarrhea, as a side effect of chemo & radiation ?

A
  • Hydration

- Electrolytes

108
Q

True or False: If the bowel is in the Tx field (if pt has colon cancer, cervical cancer, etc), if the intestine is in that window, the pt will have GI side effects ?

A

True

109
Q

True or False: In general chemo & radiation will cause GI effects ?

A

True

110
Q

What GI effect is defined as Alterations in the mouth and tongue ?

A

Stomatitis

111
Q

What is Stomatitis ?

A

erythema and dryness of the mouth

112
Q

What is Mucositis ?

A
  • erythema
  • White layer
  • thick at times
  • white layer of mucous
    (like gooo –> just like thick saliva)
  • Pt’s have trouble spitting it out
113
Q

What is Candidiasis ?

A

White patches on the tongue, in the cheeks

(will look different than mucositis)

  • needs Tx with Antifungals
114
Q

What is Herpes Simplex ?

A

Can cause vesicles or blisters in the mouth

115
Q

What are types of alterations in the tongue and mouth ?

A
  • Stomatitis
  • Mucositis
  • Candidiasis
  • Herpes Simples
116
Q

In pt’s with Stomatitis/ any alteration in the mouth and tongue what do we want to make sure to do ?

A

Assess & inspect the mouth with a flashlight every single day, probably even twice a day !

117
Q

What are some pt teaching points for pt’s with stomatitis/alterations in the mouth and tongue ?

A
  • Soft toothbrush
  • regular flossing
  • Mouthwash with normal saline
  • Avoid irritants
    (tobacco, ETOH, spices, commercial mouthwash)
  • Good nutrition/hydration !!
118
Q

What do we want to teach patients who experience Diarrhea as a side effect of cancer treatment ?

A

Want to teach these pt’s to take care of their rectal area when experiencing diarrhea

  • Because: tissue is sensitive if it is coming into contact with stool
  • The tissue can break down, causing a portal of entry or bacteria which could cause infection
119
Q

What things can we suggest for pt’s experiencing Diarrhea to utilize ?

A
  • Warm baths

- Steroid creams to the rectal area to reduce inflammation

120
Q

What skin change can we see with Radiation ?

A

Erythema

121
Q

What are the two things that we can see from Erythema from Radiation ?

A
  • Dry desquamation

- Wet desquamation

122
Q

What is Dry desquamation ?

A

Peeling

123
Q

What is Wet desquamation ?

A

Peeling of the skin with weeping serous (clear) fluid

  • This greatly increases the risk for infection
124
Q

Which cancer treatment causes skin changes that can look like sunburn type reactions ?

A

Radiation

125
Q

What do we want to assess in pt’s recieving cancer treatment in regards to the integumentary system ?

A

Want to assess the skin each day after Tx

  • the skin will continue to get more red with each passing day with Tx
  • There are times when we have to wait a day or two between treatments to allow the skin to recover a little bit from the injury
126
Q

What is a side effect of chemotherapy in relation to the skin ?

A

Erythrodysesthesia syndrome

  • Is a hand & feet syndrome that can cause
    - redness, tingling, some skin breakdown, etc.
127
Q

What are patient teaching points about the skin for patients receiving cancer treatment ?

A
  • No deodorant
  • No irritants
  • No perfumes
  • Keep the skin moist (no irritating lotions)
  • Protect skin
128
Q

What is Alopecia ?

A

Hair loss

129
Q

True or False: In some cases the skin breakdown from cancer treatment is treated as a burn, with gasoline gauze ?

A

True

130
Q

How long does it usually take for Alopecia to start if its from chemotherapy ?

A

within 3-4 weeks of the beginning of chemo

131
Q

True or False: The degree of alopecia depends on the type and dose ?

A

True

132
Q

What are patient teaching points for Alopecia ?

A
  • Hair loss occurs 10-21 days after drug treatment
  • Hair loss is temporary, and grows back when the drug is stopped
    (for chemo, hair typically grows back in 3-4wks after chemo has been completed)
  • hair loss may be sudden & in large amounts
  • Select wig or cap before hair loss occurs
    (depends on the pt. if they want to)
  • Avoid hair dryers, curling irons, & harsh or frequent shampoos
  • Keep head covered
    - Summer - to prevent sunburn
    - Winter - to prevent heat loss
133
Q

True or False: Pulmonary side effects of chemo & radiation can be progressive & irreversible at times ?

A

True

134
Q

Can pulmonary effects of chemo & radiation be acute and late ?

A

Yes

135
Q

What are pulmonary effects of chemo & radiation ?

A
  • Pneumonitis - r/t radiation
  • Pulmonary toxicity - causing tissue damage
  • Non-cardiogenic pulmonary edema
    • d/t damage of the lung tissue from Tx’s
136
Q

Because pulmonary side effects can come on late, what types of things do we want to inform pt’s to report ?

A
  • SOB
  • Difficulty breathing w/ activity
  • etc,.
137
Q

What types of Cardiovascular damage occur from chemo & radiation ?

A
  • Damage to
    - pericardium
    - myocardium
    - valves
    Or
    - coronary blood vessels

Such as….

  • Pericarditis
  • Cardiotoxicity
138
Q

What types of things can Cardiotoxicity cause ?

A
  • Dysrhythmias
  • Left ventricular dysfunction
  • Heart Failure
139
Q

What is a medication that is used in pt’s experiencing Cardiovascular effects from chemo & radiation ?

A

Adriamycin

140
Q

What do we know about the drug Adriamycin ?

(cardiovascular drug)

A
  • It’s cardiotoxic

* there is a limited lifetime dose with this medication because of Cardiotoxicity

141
Q

What do we want to monitor in pt’s who are receiving the drug Adriamycin ?

A

the pt’s ECG’s before their started on the medication & throughout Tx.

(baseline & periodic ECG to monitor how the pt is handling the effects of the drug)

142
Q

What types of cancer/diseases can cause cardiovascular effects from chemo & radiation ?

A 
Radiation to the chest
- Lung cancer
- Breast cancer
- Hodgekin's disease
   (there are some lymp nodes in the chest area that require radiation)
143
Q

In regards to chemo & radiation and the bladder, what can we give sometimes ?

A

Sometimes there are meds we can give when we know they will be toxic to the bladder

144
Q

When the kidneys are receiving chemo & radiation, what do we want to monitor ?

A

BUN & Creatinine

145
Q

What do we know about chemo & radiation, but especially radiation and the effects it can have on the reproductive system ?

A

It can cause Sterility/Infertility

Med Surg II (13 decks)

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